Impact of Hyperemesis Gravidarum

Nausea and vomiting during pregnancy (NVP) can be mild (morning
sickness) or more severe (hyperemesis gravidarum). NVP impacts
a woman and her family greatly in every aspect of her life.
The greatest impact is on her physical health and ability
to perform her usual activities. The research on morning
sickness shows that the greater the severity of symptoms,
the greater the effect on the mother:

"The most profound effect of NVP
is on maternal quality of life. NVP can have an impact on
several levels: physical functioning (interference
with work, household activities), psychological functioning
(anxiety, depression), and social functioning (disruption
of social activities)."

According to Motherisk, a organization
that researches the safety or risk of drugs, chemicals
and
disease during pregnancy:

55% of pregnant women feel depressed

49% of women report NVP has adverse
effects on relationship with their spouse

55% of their partners mentioned that
NVP has affected their day-to-day life

47% of working women felt job efficiency
to be reduced

78% of women lost paid employment
time (62 hours on average)

68% of women went on sick leave

Quoted from "Burden
of the Disease" presented by Anthony R. Scialli,
MD at "Nausea and Vomiting of Pregnancy: What's New?"
The Reproductive Toxicology Center Satellite Session; September
3, 2000

Hyperemesis Gravidarum Compared to Morning
Sickness

Women with the most severe nausea and vomiting (HG) are unable
to care for themselves or their families for weeks, sometimes
months. Some women may be unable to eat for lengthy periods
and lose 5-10% or more of their pre-pregnancy body weight
in the first few months. This in turn leads to debilitating
fatigue, and sometimes depression. Even women who do not have
severe nausea and vomiting (HG) sometimes choose elective
termination (abortion) to avoid the misery and stress they
will face.

Area Impacted:

Morning Sickness:

Hyperemesis
Gravidarum:

Employment

May lose an
average of 0-3 weeks of employment and/or use sick
time. Job performance is reduced.

Often are unable to work for
weeks or months and may lose their job or be forced
to resign.

Daily Activities

Can perform
most household responsibilities at some point during
the day or week when symptoms are less intense.

May be unable
to perform even simple household chores or care
for themselves (shower, drive, etc.) when symptoms
are severe.

Energy Level

Fatigue is
mild to moderate and decreases workload. Recumbent
rest is needed to alleviate symptoms.

Fatigue may be severe for weeks
or months. Bed rest is often a necessity. Prolonged
fatigue is very common.

Relationships
& Socialization

Relationships
may be stressed but social functioning is only temporarily
curtailed.

Relationships
are often greatly strained and may dissolve. Isolation
is common and may lead to depression. Abuse and
neglect of the mother may occur.

Finances

Financial loss
due to medical care, loss of work, and use of sick
time is significant but usually within a few thousand
dollars.

Financial loss due to medical
care, loss of income, and additional paid services
(child care, house cleaning, errands, etc.) can
be devastating.

Stress Level

Psychological
stress is mild to moderate and may result in manageable
depression during pregnancy.

Psychological
stress is typically moderate to severe and often
results in anxiety and depression. Increased risk
of postpartum depression (PPD).

Recovery

Postpartum
recovery is typical and usually takes a few months.

Postpartum recovery is prolonged,
averaging 6 months – 2 years.

Statistics for HG's Impact Are Underestimated

Morning sickness refers to mild nausea and vomiting of
pregnancy, while hyperemesis refers to more severe forms
of nausea and
vomiting. The criteria used to diagnose HG often varies among
health professionals and researchers. Very little research
is done on the impact of hyperemesis
as differentiated
from morning sickness.
Thus,
actual statistical
information is limited, and the impact of HG is greatly underestimated.
Women who are very severe are typically hospitalized, representing
only the 1-3% of pregnant women actually identified as having
HG. The majority of women with HG are treated as outpatients
with mild to severe symptoms. Further, there are reports
from hundreds, if not thousands, of women who terminated
out of desperation when given the diagnosis of morning sickness
and given inadequate treatment. One study by Zhang, et al
of 1867 women found a 10.8% incidence of severe vomiting.
Many women
are not
represented
in current statistics which only
report the number of women
hospitalized as inpatients. HG is not a rare disorder.

Estimates on the cost of inpatient care in 2000 was about
$3,300 per stay for a total of $120 million. However, in
recent years, the number of hospitalizations has increased
and the number of women receiving IV nutritional therapies
and expensive (yet often much more effective) medications
has grown significantly. Adding to that cost supplemental
physician visits, outpatient care, consulting physicians,
and treatment for complications, and the annual cost could
reach one billion dollars. Beyond financial impact, many
family relationships dissolve and future family plans are
almost always limited. Women often lose their employment
because of the debility, and women are frequently undertreated
and left feeling stigmatized by a disease erroneously presumed
to be psychological.

More Info:

"Burden of the Disease"
A presentation by Dr. Anthony R. Scialli, MD, Director of
The Reproductive Toxicology Center in Washington, D.C.

The women described substantial effects on working, household duties and parenting activities. Findings from this study suggest nausea and vomiting in early pregnancy has a profound impact on women's general sense of well-being and day to day life activities.

Neither the cause nor the effect of severe vomiting during pregnancy is well understood. This study examines possible causes of severe vomiting and associations between this disorder and fetal outcomes. One thousand eight hundred sixty-seven women with normal singleton live births were included in the analysis. The cumulative incidence of severe vomiting during pregnancy was 10.8%. Women with chronic liver disease had a threefold increased risk of severe vomiting during pregnancy. Paternal smoking was associated with a twofold increased risk of maternal vomiting. A modest association between severe vomiting and fetal growth retardation was identified (OR = 1.4, 95% CI: 0.9-2.3). Severe vomiting was also found to be associated with preeclampsia (OR = 1.5, 95% CI: 1.0-2.4). Our study indicates that passive smoking is a risk factor for vomiting during pregnancy, which may, in turn, increase the risk of fetal growth retardation.

"...no significant differences were discovered along demographic or social dimensions between women reporting no nausea, mild nausea and severe nausea during the first trimester of pregnancy. Not surprisingly, those women experiencing severe nausea reported significantly more sleep disturbances, fatigue and irritability."

A process was identified wherein women experienced severe and unrelenting nausea and related symptoms which became progressively more debilitating, leaving them feeling uncertain about when and if they would recover. This caused the women to isolate themselves from their world in an effort to cope with symptoms. Severe nausea and vomiting of pregnancy is a complex and overwhelming syndrome.

It was found that 80% of women had symptoms, 28% experienced nausea only, while 52% had nausea and vomiting. The mean number of days from last menstrual period to onset and cessation of symptoms was 39 and 84, respectively, and 40% of women's symptoms ended abruptly. The median total number of hours of nausea per pregnancy in those 292 women experiencing symptoms was 56, with peak symptoms occurring in the ninth week. The symptom complex can be defined as episodic daytime pregnancy sickness. Seventy three of these women (35%) spent a mean of 62 hours away from their paid work because of symptoms of nausea and vomiting, showing the socioeconomic significance of this condition.